On July 9, 2013, the Centers for Medicare and Medicaid (CMS) issued a new rule requiring nursing and skilled nursing facilities to implement written agreements clearly defining their relationships with hospice providers. CMS adopted this rule, located at 42 CFR § 483.75(t), in order to improve the efficiency and quality of hospice care provided to nursing home residents. The specifics of the rule are aimed at avoiding conflicting services while fostering coordination between nursing homes and hospices.
Under the new rule, a nursing home that provides hospice services through one or more Medicare-certified hospices must have a written agreement with each hospice that is signed by an authorized representative of the hospice and an authorized representative of the nursing home. The agreement must be executed prior to furnishing hospice care to any nursing home resident and include the following:
- A listing of the services the hospice will provide
- The hospice’s responsibilities for determining an appropriate plan of care
- A listing of the services the nursing home will provide
- A description of the communication process between the home and the hospice
- A provision stating that the hospice assumes responsibility for determining the appropriate course of hospice care
- A statement that the nursing home has the responsibilities of furnishing 24-hour room and board care, meeting the resident’s personal care and nursing needs in coordination with a hospice representative, and ensuring that the level of care provided is appropriately based on the individual resident’s needs
- A delineation of the hospice’s specific responsibilities (e.g. counseling, pain medication plans)
- A provision requiring the nursing facility to immediately report to the hospice administrator all alleged violations involving mistreatment of a resident
- A delineation of the responsibilities of the hospice and the nursing home to provide bereavement services to the nursing home’s staff
A provision requiring the nursing home to notify the hospice immediately of the following:
- Significant changes in the resident’s physical or emotional status
- Clinical complications that suggest a need to alter the resident’s plan of care
- A need to transfer the resident from the facility for any condition
- The resident’s death